51231.1 No. Street /' / Lot No.
= CITY OF COPERTINO.
v WATER DEPT, APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
E AUG 9 1971
0
U Sanitary No.
m
19AL Permit No. "1-3/ /
3 Fees 9-6.3Z
s Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
`o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
'e laws applicable thereto.
0
ro n Use of Premis
o_ U
o Owner 40Address
0
c
By Address
3 y
Contra or,Agent
o Phone
3 T�
m
.a State License /n Approve
I� Plumbing Inspector `�
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prot). Line
Lavatories To Existing
Kitchen in Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size ']
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee /
Area Drain Main Drain Fee '
Water Leader Storm Drain Fee
Sprinkler System Water Sys,Fee
Re]def Valve !I Gas Fee D
Vac Breaker
Skimmer
Filter
Permit Fee
Total ( .S Total Fee G. t